期刊
ANNALS OF HEMATOLOGY
卷 97, 期 12, 页码 2491-2500出版社
SPRINGER
DOI: 10.1007/s00277-018-3454-y
关键词
HCT; ALL; AML; Relapse
类别
资金
- Junior Research Group Grant of the Interdisciplinary Centre for Clinical Research (IZKF) [2383-0-0, 2316-0-0]
- Clinician Scientist Program of the Faculty of Medicine Tuebingen
- Wuerttembergischer Krebspreis
- Deutsche Krebshilfe
- New Investigator Award of the American Society for Blood and Marrow Transplantation (ASBMT)
Allogeneic hematopoietic cell transplantation (HCT) is the treatment of choice for high-risk myeloid and lymphoid leukemias. Relapse after allogeneic HCT is associated with a dismal prognosis and further therapeutic options are limited. One potential curative approach is a second allogeneic HCT. However, there is no consensus about optimal transplant modalities, suitable patients, and entities. We performed a retrospective analysis of our institutional database to evaluate risk factors that influence survival after a second allogeneic HCT for the treatment of relapsed acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). We identified 40 patients (AML, n = 29; ALL, n = 11) that received a second allogeneic HCT at our institution. At time of second HCT, 48% of patients were in complete remission (CR). Current overall survival (OS) was 14/40 patients with a median follow-up of 64 months (range 4-140) of patients alive resulting in a Kaplan-Meier estimated 2-year event-free survival (EFS) and OS of 32%, respectively. Cumulative incidence of non-relapse mortality (NRM) and relapse at 2 years was 31 and 37%, respectively. We identified several independent risk factors influencing OS: > 6 months from first to second transplant (p = 0.02), complete remission prior to transplant (p = 0.003), and the subsequent occurrence of chronic graft-versus-host disease (p = 0.003) were associated with a significantly improved OS. In conclusion, our data suggest that a second allogeneic HCT is a curative treatment option for relapsed acute leukemias in selected patients.
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